The Many Faces of Polycystic Ovarian Syndrome

The Many Faces of Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is considered to be the leading cause of female infertility, with nearly 5 million women in the United States alone carrying the markers for this disease.

Women diagnosed with PCOS typically fall into two categories; insulin resistant and non-insulin resistant, but did you know there may be up to 5 variations of PCOS?

Symptoms can include:

Excessive hair growth on the face, chest, stomach and back

Irregular or absent periods

Acne and oily skin

Ovarian cysts

Excessive weight carried around the stomach

Pelvic pain

Skin tags

Sleep apnea

Infertility

In order to meet the diagnostic criteria, a patient must present with at least two of the following three issues:

1. Increased Testosterone

2. Abnormal Ovulatory Patterns

3. Polycystic Ovaries

For women with PCOS, this is all basic knowledge. What they may not fully understand, however, is how their presentation of PCOS may differ from the experiences of others.

Two Main Types of PCOS

Presentations of PCOS can typically be broken down into two categories: Insulin-Resistant PCOS and Non-Insulin-Resistant PCOS. The variations in these presentations can create confusion surrounding the disease, as well as the best treatment options.

Insulin-Resistant PCOS

Insulin-Resistant PCOS is also referred to as Type 1 PCOS, and it is what is most often associated with the classic symptoms of PCOS. These include weight gain, ovulatory interruptions, facial hair, hair loss and acne. Those with Insulin-Resistant PCOS also exhibit a greater potential for developing diabetes and increased testosterone levels – both of which are actually caused by the underlying insulin and leptin resistance.

In fact, the insulin and leptin resistance experienced by these patients is the culprit behind many of the unbecoming symptoms they face at the hands of this disease. It leads to the increased weight gain, for instance, and the resulting excess in testosterone is to blame for the combined hair loss and facial hair growth.

The goal for treating Insulin-Resistant PCOS is to improve insulin sensitivity. Often doctors will prescribe weight loss, but it can be difficult for patients with this type of PCOS to lose weight. It requires extra dedication to both diet and exercise, and an understanding that the weight will not come off as quickly as it may for others. However, when weight loss is achieved, symptoms do typically subside. Medications to lower blood sugar are also often prescribed, although there have been natural alternatives – such as Inositol – which have been found to be just as effective in some cases.

Non-Insulin Resistant PCOS

There are some women who meet the diagnostic criteria for PCOS, but who don’t present with insulin resistance. This is what is referred to as Type 2, or Non-Insulin Resistant, PCOS. There can be a variety of causes for this type of PCOS, including Vitamin D or Iodine deficiency, hormone-disrupting toxins, thyroid disease, and adrenal stress. For women experiencing Non-Insulin Resistant PCOS, blood sugar lowering drugs will have no effect on the condition, and neither will reducing weight or going on the pill.

The treatment options in this case tend to be more natural. Patients may be encouraged to avoid dairy while also being prescribed supplements such as Iodine, Vitamin D, Magnesium, and Zinc, along with herbal formulas to reduce testosterone. Natural progesterone may also be prescribed in an attempt to balance hormones and encourage ovulation.

Other Potential Combinations

While the two types of PCOS described above tend to be the most typical presentations, there are some who break the categories down to as many as five different types:

1. Type 1 PCOS:

The classic PCOS presentation described above, with ovulatory issues, increased testosterone, and insulin-resistance.

2. Type 2 PCOS:

The non-insulin-resistant PCOS we have already described, with ovulatory issues and increased testosterone levels.

As you can see, there are many variations when it comes to this condition, which can make finding the appropriate treatment for individual patients difficult. Understanding the factors behind your own case of PCOS, and finding a specialist you trust to help you seek the answers you need is the best way to combat this disease which affects so many others as well.

[-] 41 Comments

My endoncrinologist said I have PCOS bc of my blood work, my testosterone levels are low? 15 when the normal is from 9-55, everything is in normal ranges but she said that the ratio of DHEA sulfate with this other hormone is the ratio of someone with PCOS. I do not have insulin resistance, my thyroid antibodies are high but my TSH is normal. I went to see a gynecologist and she said there’s no way I have PCOS because I have a regular period we also did an ultrasound and everything was “normal”. The only obvious symptom I have so far is acne. She said to just keep eating healthy and working out, but will that alone take care of this syndrome?How do I know if I will be able to get pregnant?

There are many parameters for detecting PCOS. I am sorry your care providers disagree. Is your endocrinologist aware of the ultrasound results?

If you have a regular cycle and are ovulating monthly, the conception may be possible.

Do continue with your healthy diet and lifestyle, and regular exercise. Be sure to include healthy fats – coconut oil, nuts and seeds, avocado, lean grass-fed protein in moderation, free-range eggs, etc. – and “slow carbs” or comlex carbohydrates in your diet. Limit processed food, sugar, caffeine, etc. too. A multivitamin with zinc may be worth learning about. Consider also what we share in our guide 6 Ways to Promote Hormonal Balance to Prevent Cyclic Acne. And do manage your stress too! High stress increases cortisol production and may impact testosterone production in women (as it does men).

Hi, I’m 24, and I’ve been diagnosed with PCOS since I was 15. For 7 years, I took BC, which I finally thought might be a risk, I stopped and asked my doctor to really do something about it!
The surprising part is even after stopping the pills, no symptoms that are regular for women with PCOS ever happened to me. I am 45 Kilograms, I work out regularly. I have no acne, no abnormal facial hair (any masculine kind of hair in any part of my body), estrogen, progesterone, testosterone levels are all normal according to my tests. Prolactin level is normal. FSH, TSH levels are normal. Everything is literally normal, LH is a bit high, and THE MOST annoying part: I don’t get my period naturally. Why?

So it has made it even harder to find out what type of PCO I am.
The only way I can get my period is either BC or combination of “estrogen pills +provera for the last 10 days of the cycle”…. I’m not insulin resistant either. Metformin didn’t help at all, and I’m still struggling. Why are all my hormones normal, but I have PCOS? I’m really worried that one day I may have problems with conceiving.

Have you asked your doctor your questions? What led them to diagnose you with PCOS in the absence of metabolic issues or hormonal imbalance? Could it be that you have primary amenorrhea? Have you worked out regularly since age 15 or earlier, and do you think your workouts could be at play (too much exercise)? Do you have a normal BMI? Healthy amounts of body fat are necessary for healthy cholesterol and hormone production.

Hi there. I am 21 years old and have always had irregular cycles (since age 12). At 15, blood tests indicated high testosterone. An ultrasound also showed “almost” cysts. I was put on the pill briefly but stopped. I went on the pill again last fall, but once again stopped (4 months ago). I have been able to reduce inflammation in my body by incorporating healthy fats and eliminating sugars and refined carbohydrates (lost 10 lbs too), but I haven’t gotten my period since stopping bc. I will be getting an ultrasound in a few days to see if cysts are present. Is there anything else I can do to get a better diagnosis/treatment? (preferably a natural approach)

Some more background: It was this past summer that I first started this healthier eating lifestyle, while I was still on BCP (6 months total). I immediately began to lose stubborn weight and got down to 118. My body looked healthy and feminine. This was with minimal exercise. Since going off birth control, however, I have been slowly gaining weight back despite eating healthily. There is no inflammation like before and it seems like mostly muscle (and some fat) in my legs and throughout my body. Again, with minimal exercise. However, the weight gain is not distributed in a feminine way. I don’t feel fat, but I don’t feel feminine. Is this a sign of insulin resistance?

Gaining weight is common for many women who stop birth control and if you are gaining muscle mass, this weighs more than adipose tissue (body fat) making scale numbers raise some. Perhaps it’s time to begin a more concerted exercise routine along with herbs, since things are going so well and diet is seemingly optimal. Consider learning more about the herbs:
– Saw palmetto (Serenoa repens): Saw palmetto is known to help regulate excess testosterone.
– Spearmint (Mentha spicata): Preliminary Turkish research finds drinking spearmint tea can lower free testosterone levels, without impacting DHEA or total testosterone.
– Maca (Lepidium meyenii): Maca is known to nourish the endocrine system in both men and women.

Hello, I am 21 years old and have recently been diagnosed with endometrial hyperplasia, endometriosis, fibroids, and PCOS. I am underweight and have no insulin resistance. I also do not have increased testosterone levels however I have 35 cysts and immature follicles on one ovary and a few on the other. I also have very irregular periods and don’t seem to be ovulating.
I am borderline underweight and have a really hard time gaining weight. I am also extremely tired and have pretty severe pain and bloating for 2-3 weeks every month.
Do you have any ideas or know what I should be doing differently?

Consider learning about iron-rich foods and/or supplementing iron, vitamin D and the herb Red Clover, or talking to your herbalist or healthcare provider about these. We also share several tips that you may find helpful to know in our guide Important Natural Health Tips for Women with Lean PCOS. Many of which will help the body through the other issues as well.

It may be most helpful however to consider working one on one with a fertility herbalist who can guide you in the right direction, on the right program, for your specific fertility health needs. This if offered through a Fertility Consultation. Learn more and book a Fertility consultation here…

Hi…i am 23 years old…..after starting weight training and 2 kg weight gain in my 21…..i missed my periods for 2 and 3 months…after 10 month with this condition… i start growing hair all over my upper body and cystic acne in face….then i did ultrasound showing cyst… and blood test…fsh and lh high…every thing else was normal…what type of pcos i am?
and are we born with type 1 and type 2 pcos?

I am 28 years old, I have had ovarian cysts since I was 15. I have children from a previous relationship and my husband and I have been ttc for 5 years. We saw an RE and my internal ultrasound showed multiple cysts on both of my ovaries, I don’t ovulate on my own, and my left tube is blocked. All my blood work came back normal and my cycles are regular but they diagnosed me with PCOS based on my acne, weight gain since having my last child, difficulty losing weight, not ovulating, and the cysts. We have done 3 cycles with Clomid and I responded well but unfortunately haven’t gotten pregnant yet. Which category would I fall into?

It seems like a type on non-traditional PCOS if insulin levels are fine. With that, each type can greatly benefit from dietary and lifestyle changes, as well as natural therapies. How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs is our main educational guide on this fertility health issue if you are interested. Consider also a vitamin D supplement and B-Complex, and asking your doctor about your insulin levels.

Once ovulation begins again, know that with one healthy fallopian tube, conception can still happen when ovulation occurs from the ovary on the side of that tube. So down to road, consider learning how to detect ovulation.

I hope offers a helpful place to start learning what you can do to support your fertility health naturally.

I was diagnosed with pcos in 1991, I was 16 years old., in 1997 I had my left ovary removed to a dermoid cyst. Could not fall pregnant, put on clomid, had first child in 2002, then second child in 2008, with double strength clomid. My hormones have been havoc to my life. In 2016 went to endocrinologist in Sydney, first visit he put me on metformin 500mg one morning and one at night. Did not do blood test to see if insuline resistance. So why on metformin? Only benefit I have on meds is that I have suffered with constipation all my life, tried everything, had tests, nothing worked. But metformin makes me regular. ????? I am so confused, don’t know what to do. ???

What is your diet and lifestyle like? Are you hoping to balance hormones naturally or be able to stop Metformin? I would encourage you to ask your doctor why he put you on Metformin and if it’s truly necessary. What were the indicators that you may need it if no tests were done?

PCOS presents differently in each woman who has it. It is a truly challenging fertility health issue (not that most of them aren’t) that requires dietary and lifestyle change as a #1 step. Many healthcare providers of all schools of thought feel PCOS can be remedied by dietary changes alone. So, certainly consider the tips shared in this guide as you move forward.

I have just been diagnosed with PCOS by having an internal ultrasound. Apparently just on my left ovary. I have now had the insulin resistance test and the results were normal. I have also previously had a hormone test (saliva) and my testosterone is normal. I have however got low vitamin D and cortisol is extremely high. Could this be the reason for my PCOS?

There are also many signs and symptoms of PCOS that could be related to elevated cortisol levels. Cortisol is produced by the adrenal glands, but it is controlled by the hypothalamus. Its primary function is to increase blood sugar, aid in fat, protein and carbohydrate metabolism, and suppress the immune system. Cortisol is released in response to stress.

Increased cortisol can:
– inhibit the proper production of leptin and dopamine.
– lead to weight gain, particularly in the abdominal region. Not only is this weight difficult to take off, it is also hormonally active, meaning that it’s the perfect place to store excess hormones such as “bad” estrogen.
– raise blood sugar
– contribute to estrogen dominance, which can present as a variety of symptoms including PMS, irritability, breast tenderness, bloating, headaches, anxiety, decreased libido and of course, an irregular cycle.
– directly inhibits something in your brain called the hypothalamus, which can inhibit the release of thyroid hormone.

Research shows that stress boosts levels of stress hormones such as cortisol, which inhibits the body’s main sex hormones GnRH (gonadotropin releasing hormone) and subsequently suppresses ovulation (common in PCOS), sexual activity and even sperm count for men. Therefore stress management is key! You may appreciate our stress-reduction tips share here… PCOS Infertility: Using Positive Visualizations On Your Journey to Pregnancy.

I was diagnosed with PCOS and it appears I have (somehow) both type 1 and type 2. Before I was diagnosed with PCOS I had a fainting issue and was diagnosed with hypoglycemia because of the extra insulin. I am also, however, overweight, vitamin D deficient, have hypothyroidism, and high testosterone. What category am I?

I’m sorry for all that is going on! So hard! This is best discussed with your doctor as one can’t be insulin resistant and not insulin resistant at the same time. It sounds to me from what I know (not a medical doctor though) like this is fairly traditional Type 1 PCOS. Perhaps you’ve seen our guide How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs, yet if not I think that will be helpful.

I hope the guide is helpful, but I can’t help but wonder if you may benefit from personalized support through a Fertility Consultation. By booking a Natural Fertility Consultation you will have access to: an herbalist who is assigned to you, answers to all of your questions, a detailed plan created specifically for you to get the best results with your Natural Fertility program.

I am a fit 22-year-old, and still unsure whether or not I have PCOS. My ultrasound said I “show multiple developing follicles up … impression: probable PCOS.” My symptoms were acne and irregular periods. After trying about everything I went on Diane-35. Got off and acne and cramps worsened incredibly. I found that I was growing harder hairs on my chin and upper lip as well. I went back on Diane-35 for 6months then transitioned on Yaz for the last 7months. I love what the pill does although do not want to be on it forever. I am so scared for my acne to come back or PCOS symptom worse. What do you recommend in getting off the pill to avoid acne and easy transition?

I would definitely suggest beginning the dietary changes we explain in our guide How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs. Herbs could be considered when birth control is stopped. I can not guarantee those unwanted side effects won’t resurface temporarily when transitioning off of birth control to herbs should that happen, but hopefully they would only be temporary.

We know dietary changes to be key for women with PCOS, so that is a great place to start.

Hi
This is really helpful. I always wondered why my symptoms of PCOS are a lot different. I am 18, thin and short. My periods are irregular, I have skin problems, hair loss and digestive issues. I am not insulin resistant. My thyroid and free testosterone levels are normal but my DHT test showed a slightly raised value (361 pg/mL with normal range being 24-368) From what I read I feel I have type 2 PCOS. It makes sense because I was diagnosed with vitamin D deficiency a year ago so I take supplements now. My biggest concern is my hair loss, is it because of DHT?

I have always had excessive facial hair (only one in the family, am blonde) that keeps regrowing after laser treatment & electrolysis, plus irregular periods and endometrisis that probably led to an ectopic pregnancy. No weight issues, no high levels of male hormones (according to several tests), no insulin levels. I had an ovarian cyst as a teenager, which resolved naturally. Could I have PCOS, in another form? I am now post-menopausal, still the hair keeps coming and coming.

That is a great question that I honestly do not have an answer to. My thinking is that it seems impossible to have PCOS when the ovaries have essentially stopped working post menopause. I know when estrogen production wanes/stops naturally in menopause and after, that facial hair growth and head hair thinning can be issues. It may help to work with a natural practitioner skilled in working with postmenopausal women. Consider reaching out to Dr. Aviva Romm or Dr. Tori Hudson to ask either of them maybe.

Hi there!
I’m 17 and have recently been diagnosed with pcos. I have inbalances in my LH and FSH hormones, normal testosterone, normal blood sugars, but many cysts. I’ve been put on the combined pill as to regulate my period, I’ve never had a normal pattern and I don’t know if I even ovulate. My doctor thinks I’m too young to do tests. I’ve been trying hard to change my diet cutting out all unhealthy fats and refined sugars, but I’m finding it difficult as I’m a very picky eater and trying to plan meals around college is hard.Basically my question is, if I’m not insulin resistant, do I need to put so much pressure on myself to change my diet so quickly, if I am a healthy weight (110 lbs,5ft1)

While I completely understand from personal experience meal planning and prep in college, yes having a healthy diet is key. Even the body of a lean woman who has PCOS can have trouble regulating insulin levels. Beyond helping the body properly manage insulin levels, a healthy diet helps the liver properly detoxify and metabolize excess hormones (a culprit with PCOS) and provides quality, healthy fats for proper hormone production and cholesterol (both necessary for hormonal balance), helps you stay hydrated and provides a variety of nutrients like antioxidants to boost cell health (eggs are cells).

That said, should you keep putting pressure on yourself, I don’t know. This may truly depend on your current diet and whether its causing you undue stress on top of college stress. The other important part about striving to make dietary changes now is that the longer you stick with them, the more likely they are to become habit and then your normal way of eating. This is a good thing!

Perhaps some guidance from a nutritionist would help. Your college’s student services or health services departments may be able to guide you to someone to offer support. If there is a dietetics or nutrition program major, the program may offer free student nutritional counseling as well.

This is indeed really tricky. Looking at it I wouldn’t fall into any category, but I know I’m type 1 even though I don’t have insulin resistance. I have high testosterone levels, problems with facial and body hair and ovulatory issues. The difference is that I’m lean and instead of insulin resistance I “only” have reactive hypoglycemia that is also a problem with insulin.

We know many women with PCOS are lean. We offer our guide Important Natural Health Tips for Women with Lean PCOS that outlines the most important natural health tips we have learned for women with lean PCOS. I hope that is is at least somewhat helpful as you continue to support the body in relearning and maintaining balance.

Hi! I am thin, no acne, long but regular cycles 32-38 days (ovulating 14 days before period always), normal total testosterone levels in blood tests, polycystic cysts on ovaries seen on ultrasound and only mild hirsutism. Testosterone levels are normal <0.69 nmol/l. What type of PCOS do i have? I am confused and thanks for your reply. I appreciate the help you are giving. I am taking maca, turmeric, omega 3 vitamins and trying to add a healthy lifestyle already. Thanks

There are so many ways PCOS presents itself from what I hear from those who reach out to us. Be sure to ask your healthcare provider to explain to you what type of PCOS it is that you have. It may be non-insulin resistant PCOS (with long cycles, cysts and mild Hirsutism).

Hay! I am 25 year old and I have PCOS. I have regular periods. I have never missed my period. I am have excessive hair growth. I went for blood tests and they showed normal ovulation and high testosterone levels. My doctor put me on Metformin. I took it for a few months, then I left it. I want to ask, is it possible to get pregnant with PCOS easily if I am ovulating? What type of PCOS do I have?

I can not know if pregnancy with any fertility health condition will be easy. Each case is so very different. If the menstrual cycle, ovulation, uterine lining and eggs, and of course hormone balance are healthy, there may be a chance of natural conception.

Given what you have shared here and the information in this article, the PCOS experienced most closely resembled #5 Idiopathic Hirsutism. Idiopathic Hirsutism presents as excess hair growth in the pattern of male hair growth (face, chest, back, groin, inner thighs etc.), eleveated testosterone levels, but the women who experience this have normal menstrual cycles including ovulation.

It is great to hear of how the Fertility Cleanse supported you. If you are interested in sharing your success story, it may encourage others.

It is difficult for me to answer your question based on just knowing a small piece of the bigger picture of your fertility health. Consider booking a Fertility Consultation to be guided in how to best support your fertility health needs. This allows you to work one on one with our fertility herbalist who will create a natural fertility program for you.

Hi there :),
Im 30, I had ultrasound and was told I have cyst few years ago, them developed acne, for a while hot flashes, and facial hair. Trying to conceive now, reading everything on the web, Im taking following:
Cinnamon
Vitex
DIM
Evening Primrose oil
Hemp Oil
l tyrosine
Vit D 30000iu
Maca
Just ordered:
Gymenna, Burdock root, Tribulus, and more Organic vitex to change brands.
Im coming from an extremely high diet on fruit now eating with your recommendations.
I dont know which type of PCOS I fall into, would these supplements contraindicated to any type of PCOS??

Without knowing the proper dose or combination that may be right for you, it would really be best to consider a Fertility Consultation with an herbalist or natural healthcare practitioner, such as a naturopath, someone who can help you determine if these herbs and supplements are right for you.

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